Bulimic Patients Research Articles

Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders: Comparing Anorexic and Bulimic Patients.

Eating disorders (EDs) represent a wide range of clinical symptoms related to food intake, body image, and weight issues, and include anorexia nervosa-restricting type (AN-R), anorexia nervosa-binge-purge type (AN-BP), and bulimia nervosa (BN). The aim was to investigate the characteristics of attachment, mentalization, emotion dysregulation, and empathy in a sample of 102 patients with EDs. A sample of 102 patients and therapists completed a series of measures for the assessment of ED pathology, mentalization, empathy, and emotion dysregulation. Pearson correlations and analysis of variance were used to test the characteristics of the variables among the groups. In relation to attachment and emotion dysregulation, no significant differences were found. In relation to mentalization, significant difference in good mentalization was found in AN-R subtype compared with the BN subtype. In relation to empathy, results showed significantly lower scores in BN subtype on affective empathy compared with the AN-BP subtype, and in AN-R subtype on cognitive empathy. Finally, we used Z-scores for each item ranked by value (higher to lower) to develop different clinical prototypes for each group. Our results point toward the clinical need to address the assessed variables, specifically mentalization, emotion dysregulation, and empathy, in the diagnosis and treatment of EDs.

The ‘satisficing’ additive composite approach to bulimia

Bulimia (‘ox hunger’) is a serious, potentially dangerous, eating disorder that is often associated with anxiety about weight and body shape. People with bulimia ‘binge’, meaning that they eat large amounts of food, and then vomit afterwards to ‘purge themselves’ in order to get rid of those recently ingested calories. Frequent vomiting of the stomach hydrochloric acid and other ingested acids (pH 1–2) produces variable, but often catastrophic, erosion of the palatal aspects of the upper teeth in particular. ‘Satisficing’ is a word made from combining ‘sufficient’ and ‘satisfactory’. It means seeking an outcome that meets the essential requirements for it to be ‘sufficient to be satisfactory for that situation’. These authors recommend pragmatic early additive direct resin composite bonding as being a ‘satisficing’ approach to help manage tooth surface loss in bulimic patients, and the article provides clinical examples of some dental problems caused by bulimia being solved in that way. CPD/Clinical Relevance: This article addresses a number of controversial issues in the dental management of patients with bulimia nervosa (‘bulimia’).

Mental health and health behaviours among patients with eating disorders: a case–control study in France

BackgroundEating disorders (ED) are a public health concern due to their increasing prevalence and severe associated comorbidities. The aim of this study was to identify mental health and health behaviours associated with each form of EDs.MethodsA case–control study was performed: cases were patients with EDs managed for the first time in a specialized nutrition department and controls without EDs were matched on age and gender with cases. Participants of this study filled self-administered paper questionnaire (EDs group) or online questionnaire (non-ED group). Collected data explored socio-demographics, mental health including anxiety and depression, body image, life satisfaction, substances and internet use and presence of IBS (Irritable Bowel Syndrome).Results248 ED patients (broad categories: 66 Restrictive, 22 Bulimic and 160 Compulsive) and 208 non-ED subjects were included in this study. Mean age was 36.0 (SD 13.0) and 34.8 (SD 11.6) in ED and non-ED groups, respectively. Among patients and non-ED subjects, 86.7% and 83.6% were female, respectively. Body Shape Questionnaire mean score was between 103.8 (SD 46.1) and 125.0 (SD 36.2) for EDs and non-ED group, respectively (p < 0.0001). ED patients had a higher risk of unsatisfactory friendly life, anxiety, depression and IBS than non-ED s (all p < 0.0001) Higher risk of anxiety, depression and IBS was found for the three categories of EDs. Higher risk of smoking was associated only with restrictive ED, while or assault history and alcohol abuse problems were associated only with bulimic ED. The risk of binge drinking was lower in all EDs categories than in non-ED.ConclusionThis study highlights the common comorbidities shared by all EDs patients and also identifies some specific features related to ED categories. These results should contribute to the conception of future screening and prevention programs in at risk young population as well as holistic care pathways for ED patients.Plain English summaryThis case–control study evaluated mental health and health behaviours associated with the main categories of Eating Disorders (EDs). Cases were patients with EDs initiating care in a specialized nutrition department and controls without ED were matched on age and gender with cases. Self-administered paper questionnaires were filled by ED 248 patients (66 Restrictive, 22 Bulimic and 160 Compulsive) and online questionnaire by 241 non-ED controls. Body image satisfaction was significantly worse in ED patients than in controls. (p < 0.0001). Dissatisfactory life, anxiety, depression and irritable bowel syndrome were more found in patients with all EDs categories than in non-ED (p < 0.0001). Smoking risk was increased only in restrictive patients while and assault history and alcohol abuse was increased only in bulimic patients. These results highlight the global burden of ED and related comorbidities and provide useful information for future screening, prevention and care programs.

Parent-child age gaps in patients with anorexia and bulimia nervosa and their associations with family dysfunction.

Family factors are linked to the development of anorexia nervosa (AN) and bulimia nervosa (BN). However, due to alack of direct comparison, it is still unknown whether the two entities of eating disorders differ with respect to the age gaps between parents and their affected children. In acohort of 568patients from the FamFINED study (FAMily Factors INvolved in Eating Disorders) diagnosed with eating disorders, we assessed the relationships between the parent-child age differences and family dysfunction, as determined by means of the General Family Questionnaire ("Allgemeiner Familienbogen" [FBA]). Data showed that the age difference between the mother and the affected child was significantly higher in AN compared to BN patients (29.3 ± 5.3 vs. 28.3 ± 5.1years, p = 0.017). Logistic regression confirmed that, also in adjusted models, the mother-child age difference significantly differed between the diagnoses of the two eating disorders (exp(B) = 0.918, 95% confidence interval 0.87-0.97, p = 0.004). However, the paternal age difference did not reach astatistical significance in the comparison between the two groups (p = 0.071). The two entities of eating disorders differed significantly with respect to the age difference between the mother and the affected subject. The maternal age difference was higher in anorectic than in bulimic patients from the same study population. Further research is required to identify the psychophysiological mechanisms underlying these age-dependent effects.

Links between posterior pituitary activity, psychometric profile and other endocrine abnormalities in anorexia nervosa: a multimodal evaluation

IntroductionOpioid system activity was found disturbed in several reward circuit areas in restrictive anorexia nervosa (AN) patients but also at the pituitary level. The role of this specific abnormality in AN physiopathology remains unknown.OObjectivesWe aimed to evaluate the relationship of upper mentioned AN abnormality with its classical pituitary features and eating behavior traits.MethodsPET [11C] diprenorphin binding potential (BPND) were processed for each pituitary part in three groups of young women: 12 AN, 11 recovered AN patients (ANrec), and 12 Controls. Anterior pituitary hormones and neurohypophysis (NH) 12 points circadian profile including copeptin and oxytocin, psychological scores were evaluated in these subjects as well as in 13 bulimic (BN) patients.Results[11C] diprenorphin pituitary binding was found to be fully localized in NH. Only AN patients’ NH present lower [11C] diprenorphin BPND than Controls, interpreted as a higher opioid tone. Both AN and ANrec show lower copeptin/24h than in Controls but no difference in oxytocin. BN showed increased copeptin and low oxytocin. In AN patients copeptin inversely correlate with Restrained Eating while oxytocin correlate with the External Eating score. NH [11C] diprenorphin BPND correlated with leptin but not with copeptin or oxytocin.ConclusionsNeurohypopysis opioid tone in anorexia nervosa seem not to impact the vasopressin or oxytocin release but still may interfere in gonadal axis regulation. Copeptin, a good indicator of hydration state, may be a good tool to detect hidden restrictive or purging behaviors. Specific correlates with AN psychologic features still suggest a physiopathological involvement.DisclosureNo significant relationships.

Chronic gastric dilatation with gastric fundus perforation in anorexia nervosa patient

IntroductionAs a complication of anorexia or bulimia nervosa, gastrointestinal problems such as stomach dilatation and necrosis are extremely rare. Our purpose is this case to pay attention on anorexia and bulimia patients to envisage the occurrence of chronic digestive injuries by performing the accurate diagnosis and selective prompt treatment.Case presentationA 40-year old female patient admitted to the emergency department with complaints of digestive symptoms. In his history there was just anorexia nervosa. Computed tomography and X-rays showed major gastric distension reaching the pelvis and perforation of the fundus. The large curvature of the stomach and the necrotic part was removed surgically. But the patient died in the second day after admission in the hospital because he was affected by a septic shock as a complication of distribution the infection because the doctors didn't resect whole the stomach during the open surgery.DiscussionWe report a rare case that shows gastric dilatation and necrosis post-anorexia nervosa, which requires accurate X-ray and CT scan, but treatment depends on whether or not gastric necrosis is present and the size of the necrosis. According to what mentioned in the medical literature this is the second case that cause death of the patient after surgery for treatment the gastric dilatation as a complication of anorexia nervosa.ConclusionThe thing that distinguishes this case is the large size of the extension of the stomach from the diaphragm to the pelvis and the perforation of the fundus with a diameter of 5 cm and the death of the patient after surgery, so we can add it in the medical literature to avoid the complications of these psychiatric diseases.

A Commentary on “Eating Disorders and the Rorschach” (Guinzbourg de Braude et al., 2021)

A Commentary on “Eating Disorders and the Rorschach” (Guinzbourg de Braude et al., 2021)

P 34. High-order body representations affect human body sway

Motivation & Objectives The variance of human body sway can be explained by anthropometric parameters, such as body height and weight, to some extent. However, high-level factors, such as body representations, might additionally influence postural control, as people with distorted body representations, like anorexic and bulimic patients, have shown more body sway in previous literature. Moreover, anthropometry has been seen to have a different relationship with body sway dependent on sex, showing a higher influence on body sway in males than in females. Therefore, the aim of this study is to investigate the relationship between body representations and postural control, and the influence of a participant's gender. We expected body image and body schema accuracy to affect postural control. Furthermore, gender differences were expected to alter the influence of anthropometry and body image on body sway control. Methodology Anthropometric measurements were taken in 44 young adults (26.93 ± 3.63 years) with a Seca scale and a flexible measurement tape. As body image measures Body Image Distortion (BID) and Body Image Dissatisfaction (BIDS) were assessed. Body schema was assessed with both the Hand and Foot Laterality Task (limb-specific motor imagery task) and a whole-body taking-a-posture task. Body sway was assessed in two normal bipedal quiet standing conditions with 6 trials of 35s duration each: 1) Eyes closed and 2) Head in Neck, Eyes closed. To analyze the relationship between body representations and human body sway, a Hierarchical Multiple Linear Regression was calculated with the following levels: 1) stance condition, 2) anthropometry, 3) body image, 4) body schema. Results Due to missing data and multivariate outliers, four subjects were excluded from statistical analysis. Across 40 subjects (20 females, 20 males), adding body image measures increased the explained variance significantly. Furthermore, adding body schema measures also increased the explained variance significantly. Therefore, the final model containing body image and body schema, additionally to stance condition and body height, explained around 45% of body sway. Moreover, gender differences in the relationship between anthropometry, body image, and limb-specific body schema were observed. While in females, body height and foot-specific body schema did not increase explained variance, it did so in males. In contrast, adding body image measures explained variance in females, but not in males. Conclusion High-order body representations, such as body image dissatisfaction, body image distortion, and body schema accuracy, affect the control of human body sway. Furthermore, the influence of anthropometry, body image, and limb-specific body schema on body sway control seems to be altered by gender.

Urinary Extracellular Vesicles for Renal Tubular Transporters Expression in Patients With Gitelman Syndrome.

Background: The utility of urinary extracellular vesicles (uEVs) to faithfully represent the changes of renal tubular protein expression remains unclear. We aimed to evaluate renal tubular sodium (Na+) or potassium (K+) associated transporters expression from uEVs and kidney tissues in patients with Gitelman syndrome (GS) caused by inactivating mutations in SLC12A3.Methods: uEVs were isolated by ultracentrifugation from 10 genetically-confirmed GS patients. Membrane transporters including Na+-hydrogen exchanger 3 (NHE3), Na+/K+/2Cl− cotransporter (NKCC2), NaCl cotransporter (NCC), phosphorylated NCC (p-NCC), epithelial Na+ channel β (ENaCβ), pendrin, renal outer medullary K1 channel (ROMK), and large-conductance, voltage-activated and Ca2+-sensitive K+ channel (Maxi-K) were examined by immunoblotting of uEVs and immunofluorescence of biopsied kidney tissues. Healthy and disease (bulimic patients) controls were also enrolled.Results: Characterization of uEVs was confirmed by nanoparticle tracking analysis, transmission electron microscopy, and immunoblotting. Compared with healthy controls, uEVs from GS patients showed NCC and p-NCC abundance were markedly attenuated but NHE3, ENaCβ, and pendrin abundance significantly increased. ROMK and Maxi-K abundance were also significantly accentuated. Immunofluorescence of the representative kidney tissues from GS patients also demonstrated the similar findings to uEVs. uEVs from bulimic patients showed an increased abundance of NCC and p-NCC as well as NHE3, NKCC2, ENaCβ, pendrin, ROMK and Maxi-K, akin to that in immunofluorescence of their kidney tissues.Conclusion: uEVs could be a non-invasive tool to diagnose and evaluate renal tubular transporter adaptation in patients with GS and may be applied to other renal tubular diseases.

Bulimia Nervosa: A Psychological Eating Disorder

Eating disorders are multifaceted mental health problems which require medical treatments and counseling from a psychological expert.In extreme condition,these eating disorders can cause serious health problems and may be lethal if these are not diagnosed and treated timely.Eating Disorder Hope organization has conducted a survey which revealed thatalmost 40% of teen age girls were suffering from at least one kind of eating disorder while91% of young females do dieting to reduce their weight. It has been estimated that about one million males and ten million females suffer from various types of eating disorders. &#x0D; Bulimia nervosa is one of the eating disorders. It oftens develops in teenage or early adulthood.It is common in women than men. In bulimia nervosa, a person usually eats a lot in a short period of time. It seems that the personcannot control himself fromeating food. It happens until they are painfully full and then they will purge to end their discomfort and to compensate their calories. They will purge by forced vomitinglaxatives,diuretics or excessive exercise.Frequent self-induced vomiting can contribute to inflammation of parotidgland and can result in hand calluses. It is more common in families appearing in generations.There are many risk factors for this disease like being overweight/obesity, socio-cultural pressures to have a well tonned body, psychological impacts resulting in stress and poor self-esteem. Dieting has become a part of our culture. There are manysymptoms of bulimia. For example, patients live in a fear of gaining weight, they go through the repeated episodes of abnormal eating large amounts of food in single sitting. There is a feeling which develops in patients that they cannot control what they eat and what type of food they eat, and after bingering they are forcing themselves to vomit and do more exercise to stop weight gain.&#x0D; If we leave bulimia untreated it will cause kidney problems, irregular heart rhythms, digestive issues and dental problems etc. In time treatment and diagnosis of bulimia helps the person to recover well and quick and the person can get rid of this disorder completely otherwise it can be life threatening. A person experiences bulimia to manage the emotional pain he is undergoing but it only worsens the condition and the response may be to ramp up obsessive thoughts and compulsive behaviors. Nearly half of bulimia patients have a co-occuring mood disorder and more than half of bulimia patients have co-occuring anxiety disorders. Self-harm is a common condition affecting 34% of those with bulimia. Recent studies on bulimia show that in 10-15% of male members of our society who are living with this disorder, risk of suicide has increased. Statistics show that relapse of this disorder isvery common.Relapse is occurring in about30-50% of the cases, and it isleading to common cause of death in suicide.For treatment of bulimia nervosa, you may need to go for several types. Bulimia can be reduced by taking anti-depressants or psychotherapy, but using both in combination is more fruitful to overcome this disorder. Psychotherapy is very important for patients, in which the person goes to the psychiatrist to discuss the issues related to bulimia. Educating the patient on nutrition also helps in this regard. Anutritionist can prescribe the food by which a person will feel the cravings for food to a lesser extent. In severe conditions,the patient can be admitted to a hospital because sometimes there is a need fortreatment in a hospital. In many cases it is not possible to eradicate it completely.But before the situation goes wrong, we can guide a person to lead a healthier life with the help of professionally used treatments. Since we are living in an era where everyone is busy, it is important to guide and educate the children about a healthy lifestyle. There is a need to give them confidence about their physical appearance, no matter what their weight, size and shape is. Enjoyable family meals should be arranged on daily basis or regularly. Talks on physical appearances, body weight and dieting should be discouraged at home. Exercise, walk, activities like sports and swimming can help young generation to adopt a healthy lifestyle and streamline their daily life. If you observe that someone in your friends or relatives is having issues related to food which is indicating thathe or she can possibly has an eating disorder, you should talk to the person supportively and discuss the issue and help them in any way you can before the situation gets worse.

Dental aspects of purging bulimia

vomiting, which in long term can result in irreversible loss of dental tissue, most commonly manifested as dental erosion. Frequent purging, xerostomia, lack of oral hygiene and acidic environment are also suitable for caries development. The aim of the research was to determine the presence, localization and degree of dental erosion using Basic Erosive Wear Examination (BEWE) index system, as well as to determine the Decayed, Missing and Filled Teeth (DMFT) index in purging bulimic patients. Methods. The study involved 30 purging bulimic patients and 30 healthy subjects. Used methods were survey (questionnaire) and clinical examination. The clinical examination included intraoral inspection and assessment of dental status using BEWE and DMFT index. Results. On the bases of conducted research, it has been found that dental erosion are significantly more often present in purging bulimics compared to the controls (?2 = 5.963, p &lt; 0.05), that eroded lesions are more severe in the bulimic group (t = 3.925, p &lt; 0.05) and predominantly located on oral surfaces of the teeth (?2 = 10.561, p &lt; 0.05). DMFT index values showed no significant difference between bulimic patients and controls (t = 0.741, p = 0.461). Conclusion. Dental erosion are often encountered in patients suffering purging bulimia, especially on oral surfaces of anterior teeth that come into direct contact with gastric acid, so many bulimics exhibit high values of erosive tooth wear on mentioned surfaces. DMFT index score did not show significant differences compared to healthy participants, but due to complexity of carious process further investigation is necessary.

Immunoglobulin G modulation of the melanocortin 4 receptor signaling in obesity and eating disorders

Melanocortin 4 receptor (MC4R) plays a key role in regulation of appetite activated by its main ligand α-melanocyte-stimulating hormone (α-MSH) in both central and peripheral targets. α-MSH also binds to circulating immunoglobulins (Igs) but the functional significance of such immune complexes (ICs) in MC4R signaling in normal and pathological conditions of altered appetite has remained unknown. To address this question, we analyzed plasma levels, affinity kinetics, and binding epitopes of α-MSH-reactive IgG extracted from plasma samples of female patients with hyperphagic obesity, anorexia nervosa, bulimia nervosa, binge-eating disorder, and healthy controls. Ability of α-MSH/IgG IC to bind and activate human MC4R were studied in vitro and to influence feeding behavior in vivo in rodents. We found that α-MSH-reactive IgG were low in obese but increased in anorectic and bulimic patients and displayed different epitope and kinetics of IC formation. Importantly, while α-MSH/IgG IC from all subjects were binding and activating MC4R, the receptor binding affinity was decreased in obesity. Additionally, α-MSH/IgG IC had lower MC4R-mediated cAMP activation threshold as compared with α-MSH alone in all but not obese subjects. Furthermore, the cellular internalization rate of α-MSH/IgG IC by MC4R-expressing cells was decreased in obese but increased in patients with anorexia nervosa. Moreover, IgG from obese patients prevented central anorexigenic effect of α-MSH. These findings reveal that MC4R is physiologically activated by IC formed by α-MSH/IgG and that different levels and molecular properties of α-MSH-reactive IgG underlie biological activity of such IC relevant to altered appetite in obesity and eating disorders.

'What should a woman do and imagine to have bulimia?': Co-constructing patient expertise in psychotherapy with bulimia patients.

One of the goals of psychotherapy with bulimia patients is identification of the functions of the eating disorder in their lives. Thus, as in any psychotherapeutic approach, the therapist should facilitate the patient's disclosure of his or her experience of living with bulimia. Talking about one's dysphoric experiences and, particularly in the case of bulimia, symptoms and experiences that commonly deprive people with bulimia of dignity, constitutes an emotional challenge for the patient and an equally challenging interactional task for the therapist. Using the example of one therapy session with a female bulimia patient, we examine how the therapist and the patient interactionally engage in co-constructing the patient's expertise - involving epistemics of experience as well as epistemics of expertise - concerning the illness in the interactional here-and-now. Applying tools and insights from discourse and conversation analysis, we examine the sequences in which the patient shifts the topical focus from a general observation concerning bulimia to her personal experience, to be further pursued interactionally by the therapist. We also discuss how the therapist downgrades her epistemic position and (concurrently) foregrounds and bolsters the patient's voice as expert to accomplish the session's therapeutic goals.

A Lack of Clinical Effect of High-frequency rTMS to Dorsolateral Prefrontal Cortex on Bulimic Symptoms: A Randomised, Double-blind Trial.

Studies suggest that stimulation of the left dorsolateral prefrontal cortex (DLPFC) reduces food craving in bulimic patients, but evidence supporting repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool is lacking. We investigated the safety and therapeutic efficacy of an adjunct high-frequency rTMS programme targeting the left DLPFC. Forty-seven women with bulimia nervosa were randomised to a real or sham stimulation group. The real group underwent 10 rTMS sessions, each consisting of 20 trains of 5 seconds with 55-second intervals between trains, at a frequency of 10 Hz. The main outcome was the number of binge episodes in the 15 days following the end of stimulation. Overall, no significant improvement in bingeing and purging symptoms was noted after the programme. rTMS was well tolerated. This suggests that 10 sessions of high-frequency rTMS to the left DLPFC provide no greater benefit than placebo. Future studies should consider methodological issues as well as alternative targets. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Interleukin-7 Plasma Levels in Human Differentiate Anorexia Nervosa, Constitutional Thinness and Healthy Obesity.

IntroductionInterleukin-7 (IL-7) is a cytokine involved in energy homeostasis as demonstrated in rodents. Anorexia nervosa is characterized by restrained eating behavior despite adaptive orexigenic regulation profile including high ghrelin plasma levels. Constitutional thinness is a physiological condition of resistance to weight gain with physiological anorexigenic profile including high Peptide YY plasma level. Healthy obesity can be considered as a physiological state of resistance to weight loss with opposite appetite regulating profile to constitutional thinness including low Peptide YY plasma level. No studies in IL-7 are yet available in those populations. Therefore we evaluated circadian plasma levels of IL-7 in anorexia nervosa compared to constitutional thinness, healthy obese and control females.Materials and Methods10 restrictive-type anorexia nervosa women, 5 bingeing/purging anorexia nervosa woman, 5 recovered restrictive anorexia nervosa women, 4 bulimic females, 10 constitutional thinness women, 7 healthy obese females, and 10 normal weight women controls were enrolled in this cross-sectional study, performed in endocrinology unit and academic laboratory. Twelve-point circadian profiles of plasma IL-7 levels were measured in each subject.Results24h mean IL-7 plasma levels (pg/ml, mean±SEM) were decreased in restrictive-type anorexia nervosa (123.4±14.4, p<0.0037), bingeing/purging anorexia nervosa (24.2±5.6, p<0.001), recovered restrictive anorexia nervosa (64.2±16.1, p = 0.01) and healthy obese patients (51±3.2, p<0.001) compared to controls (187.7±28.6). Bulimic patients (197.4±42.7) and constitutional thinness patients (264.3±35.8) were similar to controls.ConclusionsLow IL-7 is part of the adaptive profile in restrictive-type anorexia nervosa, confirming its difference with constitutional thinness. Healthy obesity, with low IL-7, is once again in mirror image of constitutional thinness with normal high IL-7.

Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes

Objective: This study examines the statistical and clinical significance of symptom changes during an intensive inpatient treatment program with a strong psychotherapeutic focus for individuals with severe bulimia nervosa. Method: 295 consecutively admitted bulimic patients were administered the Structured Interview for Anorexic and Bulimic Syndromes-Self-Rating (SIAB-S), the Eating Disorder Inventory-2 (EDI-2), the Brief Symptom Inventory (BSI), and the Beck Depression Inventory-II (BDI-II) at treatment intake and discharge. Results: Results indicated statistically significant symptom reductions with large effect sizes regarding severity of binge eating and compensatory behavior (SIAB-S), overall eating disorder symptom severity (EDI-2), overall psychopathology (BSI), and depressive symptom severity (BDI-II) even when controlling for antidepressant medication. The majority of patients showed either reliable (EDI-2: 33.7%, BSI: 34.8%, BDI-II: 18.1%) or even clinically significant symptom changes (EDI-2: 43.2%, BSI: 33.9%, BDI-II: 56.9%). Patients with clinically significant improvement were less distressed at intake and less likely to suffer from a comorbid borderline personality disorder when compared with those who did not improve to a clinically significant extent. Conclusions: Findings indicate that intensive psychotherapeutic inpatient treatment may be effective in about 75% of severely affected bulimic patients. For the remaining non-responding patients, inpatient treatment might be improved through an even stronger focus on the reduction of comorbid borderline personality traits.

The effect of pre-treatment psychoeducation on eating disorder pathology among patients with anorexia nervosa and bulimia nervosa

ABSTRACTPre-treatment psychoeducation can be effective for bulimic groups, but little is known about its effect on patients with anorexia nervosa. This study investigated the impact of a pre-treatment psychoeducational intervention on outpatients with diagnoses of full or atypical anorexia nervosa (N = 54) or bulimia nervosa/atypical eating disorder at a normal weight (N = 43). Each attended a four-session psychoeducational group whilst awaiting outpatient treatment. They completed measures of eating and personality disorder pathology pre-intervention, repeating the measures of eating pathology post-intervention. Effectiveness was tested for each diagnostic group using intention-to-treat analyses. Results confirm that such psychoeducational groups reduce unhealthy eating attitudes among bulimic patients, regardless of initial levels of eating and personality pathology. In contrast, the groups were not effective for anorexia nervosa sufferers. Such groups should be considered routinely during waiting perio...

Increased ferritin levels in patients with anorexia nervosa: impact of weight gain

A few recent studies have found elevated ferritin levels in patients with anorexia nervosa (AN), indicating ferritin as a potential biomarker of disease severity. The purpose of this study was to study how body mass index (BMI) and changes in BMI affect plasma ferritin concentrations in Swedish patients with eating disorders. In a retrospective computer search from 2009 to 2014, 662 patients with an eating disorder were identified from more than 200,000 individuals with electronic medical records. Three hundred and eighty-nine patients (374 females and 15 males) were found to have at least one p-ferritin value with a corresponding BMI value. Patients with AN were compared to a combined group consisting of patients with bulimia nervosa (BN) and patients with an eating disorder not otherwise specified (EDNOS). Patients with AN had lower BMI compared to the combined group of patients with other eating disorders (BMI=16.5±1.5, n=77 vs. 21.0±4.7, n=312, p<0.001). Patients with AN also had higher plasma ferritin levels (median 42μg/L (range 3.3-310) vs. 31μg/L (range 2.8-280); p<0.001). As BMI increased in patients with AN, ferritin levels decreased (from a median of 40μg/L (7-400) to 26 (4-170), n=47; p<0.001). Measuring ferritin in patients with AN could be valuable in monitoring improvements of nutritional status, but the full clinical value of following ferritin in individual patients has yet to be determined. The study also shows how research can benefit from electronically captured clinical data using electronic health records.

Laryngeal and vocal analysis in bulimic patients

Bulimia is an eating disorder classified as a mental disorder according to DSM-IV. AimsThe aim of the study was to evaluate vocal and laryngeal abnormalities in patients with bulimia compared to a control group. Materials & methodsStudy control group. Twenty-two women were evaluated, with an age range of 18 to 34 years old. Eleven diagnosed with purging bulimia and 11 in the control group. Both groups underwent an otolaryngological, perception and acoustic evaluation. The statistic analysis was done through a chi-square test and a Kruskall-Wallis non-parametric test, considering 5% as significance level. ResultsThe bulimic group presented a higher prevalence of laryngeal abnormalities compared to the control group (p=0.000). The group with bulimia had higher GRBSI values (p=0.000) and A (p=0.022) of the GRBASI scale. The results of vocal acoustics analysis of the jitter, shimmer, PPQ and APQ were higher in the bulimic group (p=0.033). No statistical significance difference in the fundamental frequency and NHR were found between both groups. Conclusionthe bulimic patients in this study presented more laryngeal, acoustics and perception evaluation disorders when compared to a control group.

The Difficulty with Anorexia Nervosa Treatment: The psychological differences between anorexics’ and normal eaters’ approach to food

On average, it takes an anorexic patient seven years to fully recover, and a majority of those patients have at least one relapse. This relapse is not due to poor self regulation, it is due to the neurological difference that is seen in anorexics that is not seen in normal eaters or bulimic patients. People with anorexia do not have a positive or rewarding neurological reaction to food, according to fMRI images, like normal eaters do. Recovering from anorexia physically takes weeks or months, but the psychological and neurobiological differences between anorexics and normal eaters, specifically their perception of and reaction to food, makes anorexia a very complex disease that can take years to fully recover from. This comprehensive paper examines the psychological differences between people with anorexia nervosa and “normal eaters” when they approach food and feeding. Anorexia patients have three broad neurocognitive inefficiencies, which include a weak central coherence, difficulties in set shifting, and impulsivity or inhibitory control, each of which contributes to the differences seen between anorexics and bulimics or normal eaters in terms of neurological functioning.